Metabolic Liver Research Center, I. Department of Medicine, University Medical Center Mainz, Mainz, Germany.
In Vitro Liver Disease Modelling Team, Department of In Vitro Toxicology and Dermato-Cosmetology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Liver Int. 2024 Feb;44(2):344-356. doi: 10.1111/liv.15801. Epub 2023 Nov 28.
Metabolic dysfunction-associated steatotic liver disease (MASLD) typically presents with hepatic fibrosis in advanced disease, resulting in increased liver stiffness. A subset of patients further develops liver cirrhosis and hepatocellular carcinoma. Cardiovascular disease is a common comorbidity in patients with MASLD and its prevalence is increasing in parallel. Recent evidence suggests that especially liver stiffness, whether or not existing against a background of MASLD, is associated with heart diseases. We conducted a narrative review on the role of liver stiffness in the prediction of highly prevalent heart diseases including heart failure, cardiac arrhythmias (in particular atrial fibrillation), coronary heart disease, and aortic valve sclerosis. Research papers were retrieved from major scientific databases (PubMed, Web of Science) until September 2023 using 'liver stiffness' and 'liver fibrosis' as keywords along with the latter cardiac conditions. Increased liver stiffness, determined by vibration-controlled transient elastography or hepatic fibrosis as predicted by biomarker panels, are associated with a variety of cardiovascular diseases, including heart failure, atrial fibrillation, and coronary heart disease. Elevated liver stiffness in patients with metabolic liver disease should lead to considerations of cardiac workup including N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide determination, electrocardiography, and coronary computed tomography angiography. In addition, patients with MASLD would benefit from heart disease case-finding strategies in which liver stiffness measurements can play a key role. In conclusion, increased liver stiffness should be a trigger to consider a cardiac workup in metabolically compromised patients.
代谢相关脂肪性肝病（MASLD）通常在疾病晚期表现为肝纤维化，导致肝硬度增加。一部分患者进一步发展为肝硬化和肝细胞癌。心血管疾病是 MASLD 患者的常见合并症，其患病率也在同步增加。最近的证据表明，特别是肝硬度，无论是否存在 MASLD 背景，都与心脏病有关。我们就肝硬度在预测心力衰竭、心律失常（特别是心房颤动）、冠心病和主动脉瓣硬化等高发心脏病中的作用进行了综述。研究论文从主要科学数据库（PubMed、Web of Science）中检索到 2023 年 9 月前的文献，使用“肝硬度”和“肝纤维化”作为关键字，并结合上述心脏疾病。振动控制瞬时弹性成像测定的肝硬度增加或生物标志物预测的肝纤维化增加与多种心血管疾病相关，包括心力衰竭、心房颤动和冠心病。代谢性肝病患者肝硬度升高应考虑进行心脏检查，包括 N 末端脑利钠肽前体/B 型利钠肽测定、心电图和冠状动脉计算机断层血管造影。此外，MASLD 患者也可从心脏疾病筛查策略中获益，其中肝硬度测量可发挥关键作用。总之，肝硬度增加应成为代谢受损患者进行心脏检查的触发因素。
